Antibiotics combination therapy

The comorbid conditions that can affect therapy and outcomes in patients with CAP include diabetes mellitus, COPD, congestive heart failure, and renal failure.27,28 If the patient has not received antibiotics in the past 3 months, then clarithromycin or azithromycin is the recommended first-line therapy by the IDSA. If the patient has received antibiotics in the last 3 months, then the IDSA recommends using either a respiratory fluoroquinolone alone or a combination of an oral P-lactam and an advanced macrolide/azalide (e.g., clarithromycin/azithromydn). The ATS recommends combination therapy or monotherapy with a respiratory fluoroquinolone for all patients with comorbidities. The p-lactam agents recommended include high-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, and cefuroxime. 

In patients with normal gallbladder function, effective agents for eradication of chronic carriage include amoxicillin (3 g divided three times a day in adults for 3 months), trimethoprim-sulfamethoxazole (one double-strength tablet twice a day for 3 months), and ciprofloxacin (750 mg twice daily for 4 weeks). In patients with anatomic abnormalities, such as biliary or kidney stones, surgery combined with antibiotic therapy is indicated. 

Antimicrobial resistance to rifamycins develops rapidly both in vitro and in vivo [65,85,86], As a consequence, all the three members of the family (i.e. rifampicin, rifabutin and rifapentine) are used clinically as components of combination therapies [65,87], Being structurally related, rifaximin could share this potential. And indeed resistance rates, recorded in fecal strains of Enterobacteriaceae, Enterococcus, Bacteroides, Clostridium and anaerobic cocci, ranged between 30 and 90% after short-term (5 days) antibiotic (800 mg daily) treatment [82], A similar pattern was observed in 10 patients with hepatic encephalopathy after treatment with rifaximin 1,200 mg/day for 5 days [80]. 

Gionchetti P, Rizzello F, Venturi A, Ugolini F, Rossi M, Brigidi P, Johansson R, Ferrieri A, Poggioli G, Campieri M Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis. Aliment Pharmacol Ther 1999 13 713-718. 

Erythromycin has efficacy similar to tetracycline, but it induces higher rates of bacterial resistance. Resistance may be reduced by combination therapy with benzoyl peroxide. Erythromycin can be used for patients who require systemic antibiotics but cannot tolerate tetracyclines, or those who acquire bacterial resistance to tetracyclines. The usual dose is 1 g/day with meals to minimize GI intolerance. 

Use a broad initial empirical antibiotic regimen against all likely pathogens There is no evidence of higher efficacy with combination therapy... 

Abstract Resistance to modern antibiotics is currently a major health concern in treating infectious diseases. Abuse, overuse, and misuse of antibiotics in treating human illness have caused the pathogens to develop resistance through a process known as natural selection. The most common mechanism of resistance to -lactam antibiotics is the production of /3-lactamases, which destroy -lactam antibiotics before they reach the bacterial target. Over the last two decades, combination therapy involving treatment with a -lactam antibiotic and a /3-lactamase inhibitor has become very successful in controlling -lactamase-mediated bacterial resistance. Currently available inhibitors like... 

There is increasing evidence that eradication of Helicobacter pylori with combination therapy of two antibiotics (often amoxicillin with clarithromycin) with a proton pump inhibitor (e.g. pantoprazol) during one week will heal and prevent peptic ulcer disease. 

Helicobacter pylori duodenal ulcer PO 20 mg once daily or 40 mg/day as a single or in 2 divided doses in combination therapy with antibiotics. Dose varies with regimen used. 

Rapamycin, also known as sirolimus, is a new macrolide antibiotic that interacts with cellcycle regulating proteins and inhibits cell division. The main side effects are thrombocytopenia and hyperlipidaemia. There is also evidence that it causes interstitial pneumonitis, which may resolve on withdrawing the drug or dose reduction. The drug is currently being assessed for combination therapy with tacrolimus or cyclosporin. 

Some topical anti-infectives contain corticosteroids in addition to antibiotics. There is no convincing evidence that topical corticosteroids inhibit the antibacterial effect of antibiotics when the two are incorporated in the same preparation. In the treatment of secondarily infected dermatoses, which are usually colonized with streptococci, staphylococci, or both, combination therapy may prove superior to corticosteroid therapy alone. Antibiotic-corticosteroid combinations may be useful in treating diaper dermatitis, otitis externa, and impetiginized eczema. 

In this way, by reducing permeability barriers, combination therapy with antibiotic and chelating agent may enhance significantly the efficacy of suitable antibiotics in the topical treatment of local infection. 

Antibiotics can be either administered topically — as monotherapy or as part of a combination therapy — or systemically. 

Combination therapy is often used when dealing with infections caused by both aerobic and anaerobic bacteria [50,80]. Combination of metronidazole with either gentamicin or ciprofloxacin appeared to be effective in preventing infection of abdominal trauma [101] when combined with ciprofloxacin, metronidazole was affective as a preoperative antibiotic in colorectal surgery and appeared equal in efficacy to impipenem/cilastin for the treatment of complicated intraabdominal infections [103]. Combination therapy is not always indicated for the treatment of polymicrobial infections. New antibiotics, whose spectrum includes multiple classes of microorganisms (e.g., imipenem), may often preclude combination therapy. 

The fluoroquinolones have advantages over combined fortified antibiotic therapy. They are considered by many to be an excellent choice for initial treatment of non-sight-threatening ulcerative keratitis. They are readily available as commercially prepared medications that do not need to be fortified to be effective. As a result, there is less chance of contamination and less epithelial toxicity compared with fortified drops. Their wide spectrum of activity allows the patient to use only one medication, and, when compared with fiartified antibiotics, they cause less discomfort upon instillation and are also less expensive.These attributes may increase patient compliance. 

It is probable that antibiotics will reach the interior of those abscesses which are still relatively small and have only existed for a short period of time. In these cases, too, the spectrum of aerobic and anaerobic bacteria should initially be covered non-specifically by the above-mentioned combination of antibiotics. At the same time, the presence of an amoebic abscess or echinococcosis should be ruled out serologically (as quickly as possible) and aspirated material collected for bacterial and mycotic testing. Depending on the results, the respective antibiotic (and possibly fungistatic) therapy is effected. After 2-3 (-4) days, the efficacy of this targeted treatment is reviewed clinically and biochemically as well as ultrasonographically. If the treatment is considered to have been effective, it is continued until obliteration of the abscess foci is achieved. (12, 29,53, 60, 64, 74, 91, 97, 113)... 

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